Saturday, June 29, 2013

Months after being abandoned
and left for dead, a dog is now making a difference in the life of a young boy
with autism.

Last year, animal rescuers
found a maltreated puppy on the side of a road in Georgia. They nursed her back
to health and named her “Xena” the Warrior Puppy. Xena’s recovery won fans and
her story helped raise thousands of dollars for the care of abused animals.

However, it’s Xena’s relationship
with her new owner that’s creating the largest impact. Now healthy, Xena was
adopted by Jonny Hickey, who has autism, and his family. Once shy and
withdrawn, Jonny’s family says Xena has made a major difference in his life,
inspiring him to make a video to promote April’s status as both Autism Awareness
Month and Prevention of Cruelty to Animals Month.

“My name is Jonny,” starts
the video that aired on WXIA-TV, the Atlanta NBC affiliate, “and this is my
puppy, Xena. Well, my Xena was hurt really bad. By some not-so-nice people. And
I have autism. So I think we make a pretty perfect team to spread the word to
be nice to animals, and nice to kids like me.”

Sunday, June 16, 2013

I recently had the
privilege of connecting on Linkedin with Dr. Lee Wilkinson, a seasoned expert
on the topic of autism spectrum disorders (ASD). Dr. Wilkinson holds
credentials as a nationally certified school psychologist, registered
psychologist, chartered scientist, and certified cognitive-behavioral
therapist. His numerous publications revolve around the topics of behavioral
consultation, therapy, and individuals with autism spectrum disorders. After
learning about his award-winning text, A Best Practice Guide to Assessment
and Intervention for Autism and Asperger Syndrome in Schools, I hoped that he
might agree to share his insight and expertise with Preschoology readers. And
he graciously did! The information he shares here will be particularly helpful
to parents with concerns that their young child displays signs of autism.

Q: If a parent has
concerns that their child displays signs of autism, what first steps would you
recommend towards finding help?

A: My best practice
recommendation is that a child who shows signs (red flags) of autism spectrum
disorder (ASD) be immediately referred to a health care provider (pediatrician,
family practitioner) for screening. If parents are worried about their child’s development,
they should actively voice these concerns to the child’s pediatrician and not
feel as if they are an alarmist. It is especially important that a standardized
screening tool be administered at any point when parents express concerns or
have questions about their child’s social, communicative, and play behaviors.
In fact, the American Academy of Pediatrics (AAP) recommends that all children
be screened with a standardized broadband screening tool at the 9-, 18-, 24-
and 30-month visits, and an ASD-specific screening tool at the 18- and 24-month
visits. When a screening indicates a possible delay, the child should be
referred to an Early Intervention (EI) program (statewide interagency
system providing comprehensive services to infants and toddlers with
disabilities) and directly for a comprehensive assessment by an “experienced”
multidisciplinary team that includes, but not limited to a developmental
pediatrician, pediatric neurologist, speech/language pathologist,
child/clinical psychologist, special educator, audiologist, and occupational
therapist. Depending on where a parent lives, there might be a university-based
autism clinic or research facility that provides diagnostic evaluations and
intervention services. For children age three and older, evaluations and
special services can be provided through local school districts. Finally, it is
especially important that parents seek services from professionals with
training and experience in assessing and treating young children with ASD.

Q: How would you advise
a parent who has concerns that their very young child displays signs of autism,
but who is instructed by specialists to hold off on evaluations and wait until
the child is older?

A: The signs and
symptoms of autism do not generally appear suddenly, but rather develop
gradually during the first three years of life. The earlier the child is
identified and intensive intervention can begin, the better the outcomes tend
to be for children with ASD. It is important to note that there are no
“absolute” clinical indicators of autism in very young children and that there
is wide variability in the course and timing of typical development and
personalities of infants and children. Although there is some research evidence
that the cardinal features of autism can be identified very early in life, the
most reliable diagnosis is generally made by trained professionals when a child
reaches approximately 2 years of age. Because very young children are
difficult to evaluate and diagnostic tests and procedures tend to be less
reliable than those with older children, many specialists are hesitant to refer
or evaluate a child before age 3 or 4. Although ASD is a complex disorder and
often difficult to diagnose in young children, it is my opinion that it is best
to err on the side of caution which means screening and providing services for
young children who show atypical development which may be characteristics of
ASD. I recommend that parents remain clear, positive, and persistent when
discussing their concerns with their health care provider or specialist. This
includes being proactive and indicating that they want to move forward now (and
not wait) with a screening or evaluation. Even if a health care professional or
specialist continues to be reluctant, parents can contact their local early
intervention (EI) program themselves. The Autism Society of America has local
chapters which may also be of help in locating clinicians and services.
Finally, I always recommend that parents continue to be vigilant and keep an
ongoing record of behavior that appears atypical or concerning. This
information can be very useful in any future assessments.

Q: I’ve observed that
young children might receive multiple labels before specialists determine a
diagnosis of autism. For parents, this can be an emotional roller coaster and
very frustrating. How do you explain this phenomenon and help ease parents
through the process?

A: It is not unusual for many children to
receive multiples labels before being diagnosed with ASD. The delays or
atypicality in social development, communication, neurocognition, and behavior
will vary in severity of symptoms, age of onset, and association with other childhood
disorders. The challenge for practitioners is to determine if the symptoms
observed in ASD are part of the same dimension (e.g., the autism spectrum) or
whether they represent another developmental disorder. Consequently, it
can be difficult to “rule out” other developmental disorders whose symptoms are
often observed in ASD. Moreover, differences in professional opinions are particularly
evident for young children with atypical developmental concerns. A child might
present with a delay in language development and be later diagnosed with a
receptive or expressive language disorder but not demonstrate the social
impairment characteristic of ASD. A global developmental delay might also be
diagnosed. Many children identified with ASD receive an initial diagnosis of
attention-deficit hyperactivity disorder (ADHD) or a sensory processing
disorder. If a child does not receive a diagnosis of ASD, I recommend that
parents ask for an explanation as to why their child does not currently meet
the diagnostic criteria. Because ASD is a behaviorally-based diagnosis, I
suggest that parents continue to observe and carefully monitor their child’s
social and communication development. If a parent continues to have concerns
about ASD, they should seek a second opinion or ask for a reevaluation in 6
months or a year.

For more information
regarding Dr. Wilkinson’s featured text, A Best Practice Guide to
Assessment and Intervention for Autism and Asperger Syndrome in School, visit:

This wonderful resource features up-to-date information on scientifically
validated treatment options for children with ASD and a list of best practice
books, articles, and links to relevant organizations.

Wednesday, June 12, 2013

The term Autism Spectrum
Disorder (ASD) refers to a single diagnostic category that includes two core-defining features: impairments in (a) social
communication and (b) restricted and repetitive behaviors or interests (American
Psychiatric Association [APA], 2013). There is, however, marked variability in
the severity of symptomatology and need for support across individuals with ASD. Symptom
expression falls on a continuum and will vary from the significant impairment
to more capable individuals with higher cognitive and linguistic
abilities. For example, the level of intellectual functioning can range
from persons with cognitive impairment to those who score in the superior range
on traditional IQ tests, from those who are socially intrusive to those who are
social isolates, and from those with limited communication skills to those with
precocious and advanced vocabulary.

Despite having impaired
social interaction skills and unusual, idiosyncratic and sometimes intense
interests and a high degree of rigidity, many secondary school students
diagnosed with ASD possess the cognitive ability and verbal skills necessary
for higher education. Unfortunately, many capable adolescents
and young adults either do not seek or gain entry into college, or drop out
prematurely due to social isolation, difficulty with changing routines and new
schedules, problems living independently, and lack of external supports and
guidance. Although young adults on the autistic spectrum may qualify
academically for college, they often have difficult managing other aspects of
college life. Indeed, the rates of post-secondary educational participation for
youth with an ASD are substantially lower than the general population, with
previous studies indicating 40% or fewer ever attend college and very few
receive a degree (Shattuck, et al., 2012)

The dramatic increase in
the prevalence of ASD among children indicates that a correspondingly large
number of youth will be transitioning into adulthood in the coming years. In
fact, approximately 50,000 adolescents with autism will turn 18 years old this
year in the U.S. As a result, colleges and universities can expect to enroll
more students who have been diagnosed with ASD in the near future. As more
young people are identified with ASD without co-occurring intellectual
disability, it is imperative that we
begin to study the needs of young adults as they transition into postsecondary
employment and education.

A study published in the
journal, Autism, examined the prevalence of higher functioning students with
ASD at a single university both diagnostically and dimensionally, and surveyed
students on the characteristics, problems, and risks associated with ASD.
Researchers found that between .7% and 1.9% of a large sample of students (n =
667) could meet criteria for ASD depending on whether ASD is viewed
categorically or continuously, and that the true prevalence likely falls
somewhere between these two estimates. This suggests that symptoms of ASD are
fairly common among college students in this sample and that upwards of 1 in
100 students may meet criteria for an ASD diagnosis. An important finding was
that none of the students who met the formal criteria for receiving a diagnosis
of ASD had been diagnosed previously. Thus, it is possible that some college
students who would meet ASD diagnostic criteria begin their college careers
unidentified. This is concerning given the degree to which ASD symptoms were
found to correlate with other mental health problems, most notably social
anxiety and dissatisfaction with college and life overall. For example,
symptoms of ASD were fairly common among students surveyed. From a dimensional
perspective, those students scoring above the clinical threshold for symptoms
of autism self-reported more problems with social anxiety than a matched
comparison group of students with lower autism severity scores. In addition,
symptoms of ASD were significantly correlated with symptoms of social anxiety,
as well as depression and aggression.

These results have
implications for clinical and educational practice, and illustrate the
importance of screening for autism-related impairment among university
students. In the coming years, colleges and universities may expect to enroll
more students who have been diagnosed with ASD, students who meet criteria for
the disorder but who not been identified, and students who would fall into the
category of the broad autism phenotype. University administrators, educators,
and the personnel who serve students with disabilities must be attentive of
this group of individuals and identify approaches to make college a successful
and rewarding experience. Unfortunately, we know little about how best to
facilitate success and ease transitions for these students. The evidence base
informing strategies for helping this population is poorly developed. Their
needs are diverse and include problems with time management and scheduling,
self-advocacy, isolation, interpersonal difficulties, and study skills
development. The presence of psychiatric comorbidities (e.g., depression) and
academic/ life dissatisfaction must also be included among the list of
potential concerns. Although the number of 2-year and 4-year college providing
opportunities for young adults with autism has been growing in recent
years, there is a need for wider adoption of programs and resources to support
young adults with ASD as they transition into and from college. The focus of
intervention/treatment must shift from remediating the core deficits in childhood
to promoting adaptive behaviors that can facilitate and enhance ultimate
functional independence and quality of life in adulthood. This includes new
developmental challenges such as independent living, vocational engagement,
postsecondary education, and family support.

Wednesday, June 5, 2013

The Social Communication Questionnaire (SCQ; Rutter, Bailey, &
Lord, 2003), previously known as the Autism Screening Questionnaire (ASQ), was
initially designed as a companion screening measure for the Autism Diagnostic
Interview-Revised (ADI-R; Rutter, Le Couteur & Lord). The SCQ is a
parent/caregiver dimensional measure of ASD symptomatology appropriate for
children of any chronological age older than fours years. It can be completed
by the informant in less than 10 minutes. The primary standardization data were
obtained from a sample of 200 individuals who had participated in previous
studies of ASD. The SCQ is available in two forms, Lifetime and Current, each
with 40 questions presented in a yes or no format. Scores on the questionnaire
provide an index of symptom severity and indicate the likelihood that a child
has an ASD. Questions include items in the reciprocal social interaction domain
(e.g., “Does she/he have any particular friends or best friend?”), the
communication domain (e.g., “Can you have a to and fro ‘conversation’ with
him/her that involves taking turns or building on what you have said?”) and the
restricted, repetitive, and stereotyped patterns of behavior domain (e.g., Has
she/he ever seemed to be more interested in parts of a toy or an object [e.g.,
spinning the wheels of a car], rather than using the object as intended?”).

Compared to other screening measures, the SCQ has
received significant scrutiny and has consistently demonstrated its
effectiveness in predicting ASD versus non-ASD status in multiple studies. The
scale has been found to have good discriminant validity and utility as an
efficient screener for at-risk groups of school-age children. A threshold raw
score of >15 is recommended to minimize the risk of false negatives and
indicate the need for a comprehensive evaluation. Comparing autism to other
diagnoses (excluding mental retardation), this threshold score resulted in a
sensitivity value of .96 and a specificity value of .80 in a large population
of children with autism and other developmental disorders. The positive
predictive value was .93 with this cutoff. The authors recommend using
different cut-off scores for different purposes and populations (e.g., a
cut-off of 22 when differentiating autism from other ASDs and a cut-off of 15
when differentiating ASD from non-ASD). Several studies (Allen et al., 2007;
Eaves et al, 2006) have suggested that a cut-off of 11 may be more clinically
useful (Norris & Lecavalier, 2010).

The SCQ is one of the most researched of the
ASD-specific evaluation tools and can be recommended for screening and as part
of comprehensive developmental assessment for ASD (Norris &
Lecavalier, 2010; Wilkinson, 2010, 2011). The SCQ is an efficient screening
instrument for identifying children with possible ASD for a more in-depth
assessment. For clinical purposes, practitioners might consider a multistage
assessment beginning with the SCQ, followed by a comprehensive developmental
evaluation (Wilkinson, 2011, 2016). However, cut-off scores may need to be adjusted
depending on the population in which it is used. The evidence also indicates
that although the SCQ is appropriate for a wide age range, it is less effective
when used with younger populations (e.g., children two to three years). It was
designed for individuals above the age of four years, and seems to perform best
with individuals over seven years of age.References:

Chandler, S., Charman, T., Baird, G., Simonoff, E.,
Loucas, T., Meldrum, D., & Pickles, A. (2007). Validation of the Social
Communication Questionnaire in a population cohort of children with autism
spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1324–1332.

Wilkinson, L. A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schools (2nd Edition). London and Philadelphia: Jessica Kingsley Publishers.Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism
and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.

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The objective of bestpracticeautism.com is to advocate, educate, and informby providing a best practice guide to the screening, assessment, and intervention for school-age children on the autism spectrum. Timely articles and postings include topics such as screening, evaluation, positive behavior support (PBS), self-management, educational planning, IEP development, gender differences, evidence-based interventions (EBI) and more. This site also features up-to-date information on scientifically validated treatment options for children with ASD and a list of best practice books, articles, and links to organizations. Designed to be a practical and useful resource, bestpracticeautism.com offers essential information for psychologists, teachers, counselors, advocates and attorneys, special education professionals, and parents.

Best Practice Guide

Praise for "A Best Practice Guide..."

“It is rare that one book can pack so many resources and easy to digest information into a single volume! Families, school personnel, and professionals all need the extensive, and up-to-date tips, guides, and ‘must-knows’ provided here. It’s obvious the author is both a seasoned researcher and practitioner – a winning combination.” - Dr. Debra Moore, psychologist and co-author with Dr. Temple Grandin, of The Loving Push: How Parents & Professionals Can Help Spectrum Kids Become Successful Adult

“Dr Wilkinson has done it again. This updated and scholarly Second Edition reflects important recent changes regarding diagnosis and services for students with Autism Spectrum Disorder. With its numerous best-practice suggestions, it is a must-read for school psychologists, school social workers, and those who teach in general and special education.” - Dr Steven Landau, Professor of School Psychology in the Department of Psychology, Illinois State University

“This book is an essential resource for every educator that works with students with ASD! The easy-to-read format is complete with up to date research on evidence-based practices for this population, sample observation and assessment worksheets and case studies that allow the reader to apply the information presented.” - Gena P. Barnhill, PhD, NCSP, BCBA-D, LBA, Director of Special Education Programs at Lynchburg College, Lynchburg, VA

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